[Postoperative pancreatitis after pancreatoduodenectomy]. / Posleoperatsionnyi pankreatit kak oslozhnenie pankreatoduodenal'noi rezektsii.

OBJECTIVE: Retrospective assessment of the influence of postoperative pancreatitis in development of pancreatic fistula. MATERIAL AND METHODS: The study included 173 patients after pancreatoduodenectomy performed between 2016 and 2019. Postoperative pancreatitis within the 1st postoperative day was verified considering blood amylase > 125 U/L. Patients with postoperative pancreatitis (n=36) were included in the main group, the control group consisted of 137 patients without pancreatitis. Postoperative pancreatic fistula was determined according to the ISGPS 2016 classification. Statistical analysis of the effect of postoperative pancreatitis on development of pancreatic fistula was carried out using relative risk and odds ratio with 95% confidence interval in both groups. RESULTS: Postoperative pancreatitis occurred in 36 (20.8%) out of 173 patients after pancreatoduodenectomy. Pancreatic fistula occurred in 18 (50%) cases. Among 137 patients without postoperative pancreatitis, only 18 (13.1%) patients developed severe pancreatic fistula. Relative risk was 3.8 (95% CI 2.22-6.51, p<0.0001), odds ratio - 6.6 (95% CI 2.91-15.01, p<0.0001). CONCLUSION: Postoperative pancreatitis significantly influences development of severe pancreatic fistula.

[Diagnostic value of molecular biomarkers of infection in screening by Sepsis-3 criteria]. / Diagnosticheskoe znachenie molekuliarnykh biomarkerov infektsionnogo protsessa pri skrininge po kriteriiam Sepsis-3.

AIM: To compare diagnostic value of molecular biomarkers of sepsis in patients with surgical infection in screening via Sepsis-2 (Surviving Sepsis Campaign 2012, SSC 2012) and Sepsis-3 (The Third International Consensus Definitions for Sepsis and Septic Shock) criteria. MATERIAL AND METHODS: Septic patients according to Sepsis-2 and Sepsis-3 criteria were identified from general population with surgical infection. Logistic regression models quality was the criterion for assessment of diagnostic value of molecular biomarkers. Risk factors importance was estimated via odds ratios (OR) calculation. RESULTS: Sepsis-3 ROC-AUC for procalcitonin increased up to 0.933, cut-off value 2.35 ng/ml (Sepsis-2 AUC 0.768 (p=0.004), cut-off 1.72 ng/ml). Sepsis-3 ROC-AUC for presepsin increased up to 0.932, cut-off value - 772 pg/ml (Sepsis-2 AUC 0.865, cut-off 567 pg/ml). The highest risk of sepsis was observed in systemic response to inflammation combined with organ dysfunction (OR 69.667, S 0.636; 95% CI 20.03-242.4) (Sepsis-2 - OR 9.25, S 0.548; 95% CI 3.2-27.1, p<0.001). Increased levels of both biomarkers significantly increased the risk of sepsis (OR 22.5, S 0.794; 95% CI 4.74-106.6 and OR 20.97, S 0.58; 95% CI 6.705-65.6, respectively). CONCLUSION: Organ dysfunction assessment by Sepsis-3 criteria improves diagnostic possibilities in patients with suspected sepsis. Maximum predictive value is observed for systemic inflammation response combined with organ dysfunction. In these patients procalcitonin and presepsin are characterized by equivalent high diagnostic potential for evidence of infectious nature of the disease. Increased level of these markers can serve as a basis for antimicrobial therapy administration.

[Fast-track rehabilitation after anatomical lung resection: prospective single-center non-randomized trial]. / Prospektivnoe odnotsentrovoe nerandomizirovannoe issledovanie uskorennoi reabilitatsii patsientov posle anatomicheskikh rezektsii legkikh.

AIM: To present the results of fast track rehabilitation after anatomical lung resection. MATERIAL AND METHODS: Single-center prospective non-randomized trial has included patients for the period December 2014 - December 2016. Conventional protocol was applied in 124 patients, 58 patients after atypical lung resections or pneumonectomy were excluded from the study. Thus, there were 66 patients aged 61 (51; 67) years. Men/women ratio was 37:29. Lobectomy (n=55) and segmentectomy (n=11) were performed for lung cancer, metastatic injury and various inflammatory diseases in 53 (80.3%), 8 (12.1%) and 5 (7.6 %) cases, respectively. ASA risk score was II (16), III (46), IV (4). Video-assisted/open procedures ratio was 42 (63.6%) / 24 (36.4%). RESULTS: 30-day postoperative morbidity was 7.6% (5 out of 66 patients, 95% CI 3.3- 16.5). Pleural drainage tube was removed within the 1st postoperative day in 49 (74.2%) out of 66 patients. Prolonged insufficient aerostasis was observed in 3 patients followed by effective conservative treatment. Overall mortality was 3% (n=2, 95% CI 0.8- 10.4) due to pulmonary embolism and sudden cardiac death. Median of postoperative hospital-stay was 7 (6; 9) days without significant differences between groups of lobectomy and segmentectomy (p>0.05). CONCLUSION: Fast track rehabilitation protocol in thoracic surgery is safe and effective. Further studies are needed to justify early rehabilitation in high risk patients.

[Diagnosis and treatment of pancreatic head cancer followed by mesenteric-portal vein invasion]. / Diagnostika i lechenie raka golovki podzheludochnoi zhelezy, prorastaiushchego mezenteriko-portal'nyi segment ven.

AIM: To evaluate the outcomes of pancreaticoduodenectomy with mesenteric-portal vein resection for pancreatic head cancer. MATERIAL AND METHODS: Retrospective analysis included 124 patients with pancreatic head cancer for the period 2010-2017. Mesenteric-portal vein (MPV) invasion was diagnosed in 37 (29.8%) patients, tumor contact with superior mesenteric artery as a borderline resectable state was noted in 11 cases. All patients underwent pancreaticoduodenectomy with mesenteric-portal vein resection. RESULTS: Vein invasion was histologically confirmed in 19 (51.3%) out of 37 patients. At the same time, arterial invasion was absent in 11 patients with a borderline resectable tumor. CT-associated overdiagnosis of venous wall invasion was 6.4%, intraoperative overdiagnosis - 87.5%. R0-resection was achieved in 88.5% after conventional pancreaticoduodenectomy and in 78.4% after pancreaticoduodenectomy followed by MPV resection. Median survival was 17 months, 2-year survival - 41%. Among 11 patients with a borderline resectable tumor median survival was 11 months. Pancreaticoduodenectomy without vein resection was followed by 2-year survival near 68.1%. Differences were significant (p=0.02). CONCLUSION: Pancreaticoduodenectomy followed by MPV resection as the first stage of combined treatment of pancreatic head cancer is absolutely justified if circumferential involvement of the vein and contact with superior mesenteric artery or celiac trunk do not exceed 50%. Vein resection can provide R0-surgery in these cases.

[Current issues in pancreatic surgery]. / Aktual'nye voprosy khirurgii podzheludochnoi zhelezy.

AIM: To present own experience of pancreatic surgery and to analyze literature data for this issue. MATERIAL AND METHODS: We have analyzed work of abdominal surgery department over the last 5 years. Moreover, MEDLINE and RSCI databases regarding surgical treatment of pancreatic diseases were assessed. RESULTS: There were 456 pancreatectomies. Postoperative complications arose in 176 (38.6%) patients, 11 patients died (2.4%). According to world data, mortality after pancreatectomy reaches 10%. Only creation of specialized centers is proven way to improve the outcomes. CONCLUSION: Current medical assistance for pancreatic disease may be only achieved in specialized centers with large number of various pancreatic procedures. The organization of such centers is required throughout the country and certain accreditation criteria should be developed for this purpose. Targeted routing of patients to specialized pancreatology centers will be able to reduce incidence of diagnostic, tactical and technical errors.

[Intraoperative fluid therapy during esophagectomy followed by repair]. / Intraoperatsionnaia infuzionnaia terapiia pri ézofagéktomii s odnomomentnoi plastikoi pishchevoda.

AIM: To optimize fluid therapy in transhiatal eshophagectomy by using of goal-oriented infusion therapy based on stroke volume variation. MATERIAL AND METHODS: Our trial enrolled 30 patients who underwent transhiatal esophagectomy followed by repair for the period 2011-2014. Patients were divided into 2 groups. The first group (LT) included 16 patients with liberal fluid therapy. The second group (GDT) consisted of 14 patients in whom goal-oriented fluid therapy was performed. Goal-oriented fluid therapy was implemented via stroke volume variation (SVV). RESULTS: Infusion rate was 6.7 ml/kg/h and 11.5 ml/kg/h in the main and control groups, respectively. Morbidity rate was 28.6% (n=4) and 62.5% (n=10) in the main and control groups respectively. Clavien-Dindo IV complications were lung atelectasis (n=2, 14%), pneumonia (n=1, 7%). Hydrothorax required puncture was noted in 1 (7%) case. Acute respiratory failure as complication IVa was in 1 (9%) patient. In the control group complications were registered in 10 (62.5%) patients. Complications I-II degree included lung atelectasis (n=4, 25%), cervical anastomosis failure (n=1, 6%); complications IVa were observed in 8 cases (50%). It was significant respiratory failure with reduced PO2/FiO2<300. Patients of the main group required less time for postoperative mechanical ventilation (120 [90-300] vs. 315 [215-810] min (p=0.02) and ICU-stay (0.83 [0.7-0.8] vs. 1.75 [1.25-2.75] (p=0.0022).